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For the record, I am not a utilitarian, and this essay helps explain why. I hope you can at least appreciate the logic I employed in crafting my thesis. Without further ado, here is my essay, “The Duty to Die”:

For those existing with the intense pain of a terminal illness, the right to life sounds like a cruel joke. Every day becomes a choice: continuing to endure the pain of disease, taking powerful pain medications to ameliorate the discomfort, or ending one’s life. Which option to pursue can become a moral dilemma to someone battling excruciating bone cancer or advanced HIV/ AIDS. Some may choose to grit their teeth and bear it, believing they must preserve their mental clarity in the final stage of their illness. Others seek comfort in the form of potent narcotics that may render them incoherent. The morally virtuous instead choose to die on their own terms, either by their own hand or with assistance.

The moral theory of utilitarianism requires us to always choose the action that maximizes pleasure and minimizes pain for all those affected by the action. Thus the terminally ill patient must perform a wicked calculus; which of the three available end-of-life treatments will maximize pleasure and minimize pain for everyone involved? Obviously, in the situation of someone who is terminally ill, it’s doubtful there’s any hope of maximizing pleasure. Therefore, the patient needs only focus on minimizing pain.

This eliminates the possibility of sustaining one’s life without benefit of pain management drugs while maintaining moral correctness. As noted by Foley et al, “the suffering of an individual radiates throughout households, neighborhoods, and villages.” Toughing it out certainly does not minimize pain. In fact, it does the opposite; it maximizes pain and minimizes pleasure. The second option available is to continue existence with palliative drug treatments. While this does minimize the pain of the patient, the family and friends of the terminal patient continue to suffer. In their February 2010 article on Scientific American’s website, psychology professors Robert Emery and Jim Coan state:

During a particularly stressful experience, the anterior cingulate cortex may respond by increasing the activity of the vagus nerve – the nerve that starts in the brain stem and connects to the neck, chest and abdomen. When the vagus nerve is overstimulated, it can cause pain and nausea.

Few would argue dealing with a loved one suffering from a terminal illness is not stressful. Therefore, simply by being terminally ill – whether one utilizes pain management or not – a patient is causing pain to his or her friends and family. The death of the patient is also stress-inducing, and the pain of losing a loved one can last for years, decades, or a lifetime. Friends and family suffer their own pain while the ill person is dying, and after their death. The final solution available is to terminate one’s life. Suicide, whether assisted or not, can be accomplished painlessly. The terminally ill patient’s pain ends at the moment of death. This means less pain for the patient than if they had foregone medication, and the same amount (or less) than if they had opted for palliative care. The friends and family of the patient will still experience the pain of that person’s passing in the same way as the previous two options. They will, however, be spared the pain of watching their loved one languish away. The friends and family of the ill person will skip the pain caused by watching the patient slide closer and closer to death, and move directly to the pain caused by the death itself. This means less pain for those affected by the patient’s passing than if they had continued to suffer with their disease, medication or no.

Clearly, then, of the three options available to the terminally ill patient in pain – palliative medicine, no medication, or death – self-euthanasia is the option required of the morally righteous, according to the utilitarian thesis. It is the choice that maximizes pleasure and minimizes pain for all those affected by the action. The patient’s pain ceases; the suffering of family and friends is diminished. Terminally ill patients in pain not only have a right to die, they have a moral duty to pursue their own death as quickly and painlessly as possible.